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PubMed2002

The institutionalization of public health training and the health sciences.

The health of the population is determined by a number of ecological determinants in addition to medical care. Therefore a close relationship exists with the social and political context in a society. With regard to the health care system, schools of public health as institutions for training, research, and services have to focus on four main deficits in the area of information, prevention, social gradients, and the regulation of health care delivery. A task profile derives which comprises (a) training for research and services, (b) monitoring population health and setting of priorities, (c) applied research on public health, (d) consulting the decision makers, and (e) intervention and public accountability. How to perform in these areas has to be related to basic ethical principles, notably, equity, participation, subsidiarity, sustainability, and efficiency. Furthermore, international trends in modern education have to be considered as for the European Union in the Bologna Declaration of 1999, with reference to academization and internationalization of advanced studies. The resulting institutional profile of modern schools of public health is characterized by their academic basis, interdisciplinarity, and multi-professionality. The paradigm of the New Public Health is an equal merger of medical and social sciences, a predominantly postgraduate study program, an international scope, close links to the government, local networks with service institutions, and a focus on contemporary health issues. In the former socialist economies of Central and Eastern Europe a regional collaboration beyond borders (the concept of regionality) is apt to support the achievement of international standards of excellence for newly developing schools of public health.

Education, Public Health Professional↗
PubMed1971

User reaction to current contents: behavioral, social, and management sciences.

The Missouri Institute of Psychiatry Library Current Contents Service offers free dissemination of ISI's Current Contents: Behavioral, Social and Management Sciences to 144 mental health professionals employed at twelve locations in the Missouri Division of Mental Health system. The service includes free document delivery of up to 100 articles per subscription. Sixty percent of the participants in the project are sharing copies of CCBSMS with their colleagues. Operation of the service is described, and data on degree of use are analyzed by user professional orientation and hospital location. The most frequently cited journal titles are compared to lists of heavily used titles derived from other sources. These lists of titles are offered as empirical guides to frequently consulted behavioral science journals. After six months experience participants appear to be highly satisfied. Ninetytwo percent responding to an evaluative questionnaire want to continue the service another year.

Behavioral Sciences↗
PubMed1997

Gender differences in medical treatment: the case of physician-prescribed activity restrictions.

A growing scientific literature highlights concern about the influence of social bias in medical care. Differential treatment of male and female patients has been among the documented concerns. Yet, little is known about the extent to which differential treatment of male and female patients reflects the influence of social bias or of more acceptable factors, such as different patient preferences or different anticipated outcomes of care. This paper attempts to ascertain the underlying basis for an observed differential in physicians' tendency to advice activity restrictions for male and female patients. We explore the extent to which the gender-based treatment differential is attributable to: (1) patients' health profile, (2) patients' role responsibilities, (3) patients' illness behaviors, and (4) physician characteristics. These four categories of variables correspond to four prominent social science hypotheses concerning gender differences in health and health care utilization (i.e, biological basis hypothesis, fixed role hypothesis, socialization hypothesis, physician bias hypothesis). Data are drawn from the Medical Outcomes Study (MOS), a longitudinal observational study of 1546 patients of 349 physicians practicing in three U.S. cities. Multivariate logistic regression is used to evaluate the likelihood of physician-prescribed activity restrictions for male and female patients, and to explore the absolute and relative influence of patient and physician factors on the observed treatment differential. Results reveal that the odds of prescribed activity restrictions are 3.6 times higher for female patients than for males with equivalent characteristics. The observed differential is not explained by differences in male and female patients' health or role responsibilities. Gender differences in illness behavior and physician gender biases both appear to contribute to the observed differential. Female patients exhibit more illness behavior than males, and these behaviors increase physicians' tendency to prescribe activity restrictions. After accounting for illness behavior differences and all other factors, the odds of prescribed activity restrictions among female patients of male physicians is four times that of equivalent male patients of those physicians. Medical practice, education, and research must strive to identify and remove the likely unconscious role of social bias in medical decision making.

Activities of Daily Living↗
PubMedDate not supplied

[Socioeconomic inequalities and mental health. II. Methodological aspects and literature review].

OBJECTIVE: This study provides a framework for mental health inequalities beginners. It describes the methods used to measure socio economic inequalities and the inter-relations with different aspects of mental health: residence, mental health services organisation and main diagnostic categories. METHOD: Literature electronic-search on Medline, Psyclit, Econlit, Social Science Index and SocioSearch using and relating the key-words inequalities, deprivation, poverty, socio-economic status, social class, occupational class, mental health for the period 1965-2002 (June). The articles selected were integrated with manual search (publications of the same authors, cross-references, working documents and reports of international and regional organisations). RESULTS: Inequality is not an absolute concept and, mainly, it has been changing during the last years. For example, the integration and re-definition of variables that capture, in simple indices, a complex reality; the accent on social more than on economic aspects; the geo-validity and time-reference of the inequality's indices. Moreover, the inequalities could be the result of individual preferences, in this case, the social selection and social causation issues will raise the suitability for a public intervention. CONCLUSIONS: Up to now, research has been mainly concentrated in describing and measuring health inequalities. For designing effective interventions, policy makers need to ground decisions on health-socioeconomic inequalities explanatory models.

Databases as Topic↗
PubMed1993

Depression during the female climacteric period.

The paper draws attention to the increased incidence of clinical depression reported during the climacteric period of the female life continuum. It seeks to identify factors which may be responsible for this phenomenon, drawing upon research and anecdotal evidence from both the biological and social sciences. With this aim, changes during the climacteric period for women are examined within a bio-psycho-social framework. Nursing care and treatment of those suffering depression within this stage of the middle years are discussed briefly and the influence of personal beliefs, held by both the patient and clinician, emphasized. The relevance and importance of these factors when employing the Roy Adaptation model in the care of such clients is also considered. In conclusion, the author stresses the need for a holistic approach and highlights the value of Roy's model in care provision for this patient group.

Aging↗
PubMed1977

Political psychiatry: a post-Watergate perspective or the revolution of falling expectations.

The social contract is a concept equally vital to philosophy and psychology in terms more relevant to this presentation, to politics and psychiatry. From the Hobbesian point of view, the contract has to do with the rights and responsibilities of different components and classes of society vis á vis one another. From the psychodynamic point of view, the social contract has to do with the way individuals relate to each other. Common to both perspectives is the implicit recognition that certain rules will be followed and that penalties will ensue when they are not, or, at the very least, that the prospect of penality will serve as a deterrent. These two notions of social contract converge in the actual regulation of our individual and collective behavior. Governance is impossible without trust in either the rules (more commonly known as the law, or the rule of law) or the people who administer them, whether parent, judge, or senator. Laws that are accepted and a corresponding "care that those laws are failfully executed" both are necessary to a good and just society. Perhaps I can demonstrate these concepts by paraphrasing the nobel Prize winning Japanese novelist who used as a title of his prize winning novel, The Sound of the Mountain. The tearing of the social fabric is the sound of loss of trust in our government, governors, and governance. If that trust is lost, it is but a step to loss of faith in self. For me, the test of these envolving concepts is their usefulness in predicting or at least in coping with the near future. To re-establish trust is our major task. My view may be too narrow and parochial, but I think it is more than coincidental that two of the groups under severest attack as untrustworthy are politicians and psychiatrists. The response of these two groups have some dramatic and meaningful similarities. In politics or, at least, in campaign rhetoric we are seeing fewer promises and more candor; mor emphasis on truthfulness, personal integrity, and character and fewer offers to solve difficult problems. In psychiatry, and somewhat in psychology and the other behavioral and social sciences, we see a demand to reduce the role of scope of the profession, particularly in dealing with "social issues," such as poverty and racism, which commentators and critics consider to be outside the proper sphere of competence and propriety. As a political psychiatrist, I am deeply concerned. In order to avoid the pitfalls of over-promising, we are overreacting; we are movinginto a trap that combines anti-intellectualism and anti-idealism. It can be summarized briefly in what I would call "the revolution of falling expectations." This is wrong. I protest. At the risk of being accused of hubris and hutzpah, I feel that nothing less than the best intellectual capacities and abilities and the deepest and widest experience are needed to deal with our problems in both politics and psychiatry...

Government↗
PubMed2002

Odds and ends: risk, mortality, and the politics of contingency.

Medical anthropology's cogent rethinking of conventional biomedical categories has largely overlooked the core problems of one key concept of both biomedical and social scientific analysis: risk. In particular, the use of the term in medical anthropology (and the social sciences more generally) frequently rests on two assumptions: (1) that contingency necessarily constitutes a threat to individual experience or social order; and (2) that a risk management paradigm that relies on a model of statistical probability is the ontologically preeminent way of engaging chance. Other approaches which do not take risk as the starting point for understanding contingency also have problems; they too assume that contingency is necessarily cause for crisis. These problematic root assumptions lead social analysts to miss how individual actors and local communities variously engage, rather than minimize, contingency. I suggest a new approach that instead aims to treat contingency as normatively neutral and as arising in four domains of experience. Conventional approaches also miss how attempts to account for unexpected events themselves involve struggles between competing paradigms (or tropes) of chance. This contest over accountability I call here the politics of contingency, and I seek thereby to signal the need to renovate our language of uncertainty in order to address its political dimensions. I trace the literature to identify some sources of these terminological problems, and through an examination of the life and death of a close contact in Chania, Crete, I explore his own approach to chance and the different, competing interpretations of his death. I thereby demonstrate the importance of revamping the conventional approach to understanding the contingent nature of human life.

Attitude to Death↗
PubMed1996

Demographic transition theory.

Demography is a science short on theory, rich in quantification. Nevertheless, demography has produced one of the best documented generalizations in the social sciences: the demographic transition. What is the demographic transition? Stripped to its essentials it is the theory that societies progress from a pre-modern regime of high fertility and high mortality to a post-modern regime of low fertility and low mortality. The cause of the transition has been sought in the reduction of the death rate by controlling epidemic and contagious diseases. Then, with modernization, children become more costly. Cultural changes weaken the importance of children. The increasing empowerment of women to make their own reproductive decisions leads to smaller families. Thus there is a change in values, emphasizing the quality of children rather than their quantity. In short, the fertility transition is becoming universal phenomenon, in which every country may be placed on a continuum of progress in the transition.

Demography↗
PubMed2006

"A mission-driven discipline": the growth of conservation biology.

Conservation biology emerged in the mid-1980s, drawing on established disciplines and integrating them in pursuit of a coherent goal: the protection and perpetuation of the Earth's biological diversity. Opportunistic in its borrowing and application of knowledge, conservation biology had its roots within the established biological sciences and resource management disciplines but has continually incorporated insights from the empirical experience of resource managers, from the social sciences and humanities, and from diverse cultural sources. The Society for Conservation Biology (SCB) has represented the field's core constituency, while expanding that constituency in keeping with the field's integrative spirit. Conservation Biology has served as SCB's flagship publication, promoting research, dialog, debate, and application of the field's essential concepts. Over the last 20 years the field, SCB, and the journal have evolved to meet changing conservation needs, to explore gaps in our knowledge base, to incorporate new information from related fields, to build professional capacity, and to provide expanded opportunities for international participation. In turn, the field, SCB, and journal have prompted change in related fields, organizations, and publications. In its dedication to advancing the scientific foundations of biodiversity conservation and placing that science at the service of society in a world whose variety, wildness, and beauty we care for conservation biology represents both a continuation and radical reconfiguration of the traditional relationship between science and conservation.

Conservation of Natural Resources↗
PubMedDate not supplied

The relationship between social support and adolescent mothers' interactions with their infants: a meta-analysis.

OBJECTIVE: The purpose of this meta-analysis was to statistically summarize the results of independent quantitative studies regarding the relationship between social support and adolescent mothers' interactions with their infants. DATA SOURCES: The following sources were selected from 1980 to 1999: citations from bibliographies of previously located articles, dissertations abstracts, the Social Sciences Citation Indexes, and researchers at a regional conference; online sources used were CINHAL, MEDLINE, ERIC, Psych Lit, and Social Work Abstracts. STUDY SELECTION: Of a potential sample of 31 studies, 14 were excluded because they did not meet the sampling criteria, and 4 were deleted as outliers. The final sample consisted of 13 studies. DATA EXTRACTION: Each study was coded for methodologic and substantive variables, including quality indicators. DATA SYNTHESIS: Most of the studies were cross sectional in design and used a variety of measures. Together, the studies included a sample of 823 mothers. CONCLUSIONS: A medium effect size and a significant relationship between social support of adolescent mothers and their interactions with their infants were established. No difference was found in the relationship when support was provided by the family or through a network.

Adolescent↗
PubMed2005

The ecological context of interpersonal violence: from culture to collective efficacy.

This brief essay outlines the progression over the last 20 years of ecological theories of interpersonal violence. The period between the present and the early 1980s began with a revival of cultural explanations of violence that paralleled the introduction of the neo-conservative social science and then witnessed a rediscovery of deficits based structural explanations of interpersonal violence under the broad rubric of social disorganization theory. The essay concludes with a more optimistic appraisal of recent refinements of social disorganization theory that consider the mediating effects of collective efficacy on urban crime and interpersonal violence.

Child↗
PubMed1995

[Development of a health promotion program for the target group "elderly people"].

The importance of health promotion for persons in the second half of their life span is increasing. Results of different studies published at the end of the eighties show that health risks and anatomical deterioration can be effectively reduced in later life. From a medical viewpoint, these results provide the basis for preventive and rehabilitative measures. Knowledge from gerontology, social sciences and psychology demonstrates the necesserity of health promotion including the total way of life. First, the demographic and social framework for a concept of health promotion will be presented. The article will start with a short overview of the demographic-historical situation and the focus on the situations of different generations. Finally, the concrete requirements for the development of health promotion programmes will be formulated.

Aged↗
PubMed1994

Teaching social and behavioural sciences: have we delivered--have they got it?

The inception of Project 2000 and its new curriculum has set a requirement for the teaching of Social and Behavioural Sciences in the nursing programme. Subjects covered are Health Promotion, Sociology/Social Policy, Psychology, Research and Computers. These subjects are complex and this paper outlines the problems and difficulties experienced by teachers since the start of the course in 1991. The problems experienced by the students in relating theory to practice are also discussed.

Behavioral Sciences↗
PubMedDate not supplied

Milton C. Winternitz and the Yale Institute of Human Relations: a brief chapter in the history of social medicine.

This paper considers the antecedent events that led to the development of Yale's Institute of Human Relations, the program of interdisciplinary research and teaching established, and the principal protagonists, James Rowland Angell, President of Yale University, and Milton C. Winternitz, Dean of the School of Medicine, both of whom were committed to the concept that medicine is a social science.

Academies and Institutes↗
PubMed2005

An overview of the ethics of cyber-space research and the implication for nurse educators.

This paper provides an overview of the techniques available to the cyber-space researcher together with a consideration of the specific ethical issues that such research generates. It is acknowledged that these research methods are, at present, not widely utilised within health care sciences, thus this paper draws upon the experiences and debates that are current within other disciplines, predominantly those of the social sciences. The primary areas of ethical concern are suggested to be those surrounding consent, privacy, identification verification and disguise. These issues are further considered for their implications for nurse educators and for those academics that are either undertaking cyber-space research of their own or supervising student's Internet-based research projects.

Confidentiality↗
PubMed2001

The role of risk assessments in the governance of genetically modified organisms in agriculture.

Controversy abounds in the governance of genetically modified organisms (GMOs) for use in agriculture, partly due to ideological differences. Technological optimism and the "shallow" and the "deep" ecology movements are three influential ideologies that are seen to differ both on value commitments and factual beliefs with respect to GMOs. Factual matters are clarified but not resolved by science, since the scientific community faces uncertainty and apparent contradiction between different research perspectives, notably molecular biology, ecology and the social sciences. Scientific advice plays a key role in the governance of GMOs and ought to be construed so as not to exclude legitimate arguments from ideological perspectives present in the process of governance. This paper analyses the role and use of risk assessments and argues that they be replaced by forms of advice that consider a broader spectrum of scientific evidence and insights, e.g. impact assessments and evaluations of inherent sources of uncertainty and ignorance. A few practical measures to that effect are discussed.

Agriculture↗
PubMed1991

The acceptability of childhood immunization to Togolese mothers: a sociobehavioral perspective.

A study was conducted in Togo to investigate the lack of acceptance of childhood immunization from a social science perspective. In each village focus group interviews were conducted with approximately 12 mothers to discuss their beliefs and knowledge, social and cultural norms and practices, and experiences with health services that hinder or promote the acceptability of childhood immunization. The problem of failure to complete the immunization series was explained in terms of mothers' lack of knowledge of when to return or their forgetfulness rather than inadequate knowledge about the importance of returning. Other barriers included the requirement to keep and present a vaccination card, waiting time at the clinic, lack of information about available services, and laziness. Rather than endorsing strategies that target individuals, mothers suggested increasing the level of social control exerted by decision makers in their communities (the village chief could direct the town crier to announce the passing of each week to help parents keep track of time between immunizations) and increasing the level of social support by having a meeting to support the importance of completing the vaccination series and to organize mothers who go to the clinic to inform others in their neighborhoods about vaccination.

Costs and Cost Analysis↗
PubMed2002

Toward a racial abyss: eugenics, Wickliffe Draper, and the origins of The Pioneer Fund.

The Pioneer Fund was created in 1937 "to conduct or aid in conducting study and research into problems of heredity and eugenics . . . and problems of race betterment with special reference to the people of the United States." The Fund was endowed by Colonel Wickliffe Preston Draper, a New England textile heir, and perpetuates his legacy through an active program of grants, some of the more controversial in aid of research on racial group differences. Those presently associated with the Fund maintain that it has made a substantial contribution to the behavioral and social sciences, but insider accounts of Pioneer's history oversimplify its past and smooth over its more tendentious elements. This article examines the social context and intellectual background to Pioneer's origins, with a focus on Col. Draper himself, his concerns about racial degeneration, and his relation to the eugenics movement. In conclusion, it evaluates the official history of the fund.

Behavioral Sciences↗